Risk identification and monitoring
Community pharmacy teams can screen people to identify those with prediabetes. This may include filling out risk assessment questionnaires, such as the Diabetes UK Risk Score Assessment Tool with non-pregnant customers aged <40 years, people of South Asian and Chinese descent aged 25-39 years, and other adults with co-morbidities that increase the risk of type 2 diabetes.
Such conditions include hypertension, obesity, stroke, non-alcoholic fatty liver disease, polycystic ovary syndrome, cardiovascular disease, history of gestational diabetes mellitus and mental health disorders. Risk can also be assessed using NHS Health Checks.
If the initial assessment suggests a high risk, pharmacists should refer those individuals to their GP surgery for blood tests to confirm the level of risk (i.e. the second stage of risk identification with fasting plasma glucose or HbA1c).
The aim is to determine the risk of progression to type 2 diabetes or identify possible type 2 diabetes itself. HbA1c forms when red cells are exposed to glucose in the plasma and the test reflects average plasma glucose over the previous eight to 12 weeks.
The HbA1c test can be performed at any time of the day without any special preparation and so avoids the need to fast and follow prior dietary requirements unlike the oral glucose tolerance test (OGTT).
HbA1c can be affected by genetic, haematological (e.g. anaemia) and illnessrelated factors (e.g. malaria), so people with such conditions have red blood cells with an altered life span. HbA1c is therefore not a reliable diagnostic test. Fasting glucose testing is recommended in such individuals.
How pharmacy teams can make a difference
In comparison with white Europeans, people from Black African and Caribbean backgrounds are three times more likely, and people of South Asian heritage six times more likely, to develop type 2 diabetes.
Community pharmacy teams are knowledgeable about the demography of their local population and are well placed to identify and understand their health needs, so have a vital role to play in risk identification and prevention strategies.
Pharmacies can use national materials, such as NHS England resources on self-care, such as healthy eating, exercise and getting fit, healthy weight, or those prepared by local agencies to promote awareness and support the reduction of modifiable risk factors for prediabetes and type 2 diabetes.
They can also direct people to NHS approved technology (e.g. digital apps) to support beneficial lifestyle interventions.